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Direct contact: +31 (0)85 – 876 95 95
info@seniorenzorgmakelaardij.com









Intake







QUESTIONNAIRE TO PREPARE FOR YOUR APPOINTMENT

We would be happy to delve into your situation, so that we can get to know you better in advance and prepare thoroughly for the initial, no-obligation conversation. This way, we can ask the right questions right from the start and quickly gain a clear picture of your situation and needs. After all, every remigration is unique, as every person is different. Are you unable to complete this document? You can also answer the questions by email or contact our secretariat; our secretary will be happy to help you.

We handle your data with care and confidentiality. We will use the information from this form solely to assess your application and prepare for an intake interview. You can read more information in our Privacy statement.

    • 1

      Persoonsgegevens

    • 2

      Huidige situatie buiten Nederland

    1/2

    Personal data

    1. It's lovely to meet you

    How did you hear about us?

    Explanation / which / who / medium

    N.A.W. data

    Name

    Place of birth

    Last place of residence in the Netherlands

    Telephone number

    Email address

    Contact person and/or legal representative

    Is there a legal representative/guardian/conservator involved?

    If so, which applies?

    Is there a contact person?

    Contact person

    Contact person’s telephone number

    Contact person email address

    Close family, children, circle of friends

    Are there any children?

    If so, are they involved in the remittance of funds?

    Other family / friends involved

    Explanation family / circle of friends

    2. Housing and income

    Rental property

    Freehold property

    Pension income

    Pension income

    Situation description

    Your situation is unique. You once left, often with the idea of never returning. Your life has changed, leading you to consider returning, or there is even a necessity to return.

    Could you briefly tell us what's going on? Are you looking for specific information? Is there a crisis situation? Loneliness? Nothing is too crazy for us, we're happy to think along with you.

    “Every traveller has a home, and they appreciate it all the more for their wanderings.”

    Charles Dickens

    You don't have to make a decision yet.

    You only need to share what's going on.

    That's enough to make contact.





    Direct contact: +31 (0)85 – 876 95 95
    info@seniorenzorgmakelaardij.com



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